Click on a form below to open the document and print.

pdf-icon-150x150Financial Policy Form

pdf-icon-150x150Patient Information Form

pdf-icon-150x150Minor Authorization Form

pdf-icon-150x150Record Release Form

pdf-icon-150x150Adult Medical History

pdf-icon-150x150Pediatric Medical History

pdf-icon-150x150Allergy/Asthma Medical History

pdf-icon-150x150Ear Nose and Throat Medical History

pdf-icon-150x150Voice/LPR Medical History

pdf-icon-150x150Sleep Medical History

pdf-icon-150x150Privacy Policy

School Medical Forms

pdf-icon-150x150Clovis Unified Medication at School & Anaphylaxis Emergency Action Plan

pdf-icon-150x150Fresno Unified Medical Form

pdf-icon-150x150Visalia Unified Medical Form

Accepted/Contracted Plans:

  • Advantek PPO
  • Aetna Choice/PPO
  • Anthem Blue Cross PPO
  • Blue Cross PPO
  • Blue Shield PPO
  • Capitol Administrators
  • Champva Open Access
  • Cigna PPO
  • Foundation for Medical Care
  • GEHA
  • Health Net PPO
  • Humana – Choice Care PPO
  • Interplan PPO
  • Key Medical HMO with PMD Referral
  • PHCS PPO
  • Triwest (Tricare)
  • United HealthCare PPO/Choice Plus POS